Innovation Center Seeks Applications for Bundled Payment Initiative

The Centers for Medicare and Medicaid Innovation (Innovation Center) now is accepting applications for 4 models of care under its Bundled Payments for Care Improvement initiative. Hospitals, physician group practices, inpatient rehabilitation facilities, skilled nursing facilities, home health agencies, and other health care providers, can apply to participate in this new program that will align payments for services delivered across an episode of care, such as a hip replacement, rather than paying for services separately. According to the Innovation Center, bundling payment across providers for multiple services will offer a greater incentive to coordinate and ensure continuity of care across settings, resulting in better care for patients.

Three models involve a retrospective bundled payment arrangement, 1 model would pay providers prospectively. Through the initiative, providers have flexibility in selecting conditions to bundle, developing the health care delivery structure, and determining how payments will be allocated among participating providers. Applicants for these models also would decide whether to define the episode of care as the acute care hospital stay only (Model 1), the acute care hospital stay plus post-acute care associated with the stay (Model 2), or just the post-acute care, beginning with the initiation of post-acute care services after discharge from an acute inpatient stay (Model 3). Under the fourth model, CMS would make a single, prospective bundled payment that would encompass all services furnished during an inpatient stay by the hospital, physicians, and other practitioners.

Organizations interested in applying to the Bundled Payments for Care Improvement initiative must submit a letter of intent by September 22 for Model 1 and November 4 for Models 2, 3, and 4. Final applications must be received by October 21 for Model 1 and March 15, 2012, for Models 2, 3, and 4. Providers participating in Accountable Care Organizations are encouraged to submit applications. Click here for more information about the initiative and various models.

Comments

In my estimation all of these models will eliminate the physical therapist owned private practice. These models only work for physician owned surgical and ancillary service centers and hospital based centers. Medicare is assisting hospital and physician owned centers in creating care monopolies where the patient does not have freedom to chose a provider based on quality or previous relationship. Patient's under this model will be further forced to seek treatment from providers within the group that is being payed under this system.

Posted by Cynthia Sheaffer
on 8/29/2011 9:53 AM

I agree with Ms Sheaffer's comment. I do not see how this will include private practice therapist.

Posted by Tim Haller
on 8/29/2011 12:31 PM

I am completely baffled that the APTA and or the PPS have not commented on this issue. It does in my mind, eliminate the "Private PT Practice" and plays directly into "POPTS". If CMS bundles and pays the Hospital, or SNF, or a Physician group practice, the Private practice is left out in the cold. Come on APTA and PPS get involved and STOP this plan before the "Private Practice" is GONE!

Posted by Brian B Lambert PT
on 8/29/2011 5:05 PM

These models completely disenfranchises the private practitioner and our patients. Freedom of choice of a preferred physical therapist and or network would be in jeopardy. This undermines vision 2020 and autonomous practice. Decades of efforts by the A.P.T.A will be wiped out. Our profession needs to unite and have a clear and loud outcry to prohibit this move by CMS.

Posted by Laura haughie
on 8/29/2011 8:17 PM

The APTA needs to jump on this ASAP.

Posted by Dennis Engerer PT
on 8/31/2011 8:03 AM

I, too, believe this is likely the greatest issue jeapordizing the existence of private physical therapy practices, particularly small independent clinics, that we will see in our careers. As with any of these cost-saving measures, other insurers are likely to follow Medicare's lead and we will quickly be unable to sustain our practices and service to our patients. This affects our careers as well as our patients' treatment and quality of care options. APTA and PPS should act quickly, clearly and strongly to prevent this plan from becoming anything other than an option for certain large organizations, if that. Didn't we already learn years ago that quality of care and patients suffered under capitation? We won't be allowed in to these organizations, or certainly won't have a strong enough voice to protect our clinics. Our profession and leaders must act now!